1315 - Unlocking Movement: A Rehabilitative Perspective on Managing Tetanus-Induced Spasticity in a Pediatric Patient

Case Diagnosis: 9-year-old unvaccinated male with spasticity due to tetanus.

Case Description: A 9 y/o unvaccinated Amish male presented with jaw stiffness that progressed to his entire body, rendering him unable to ambulate. He was diagnosed with tetanus with unknown etiology. Initially, he received Tdap dose, tetanus immunoglobulin, and antibiotics. Given agitation, spasticity, and generalized myoclonic jerks, he started enteral baclofen, diazepam, and other paralytics and sedating agents. His spasticity improved with these medications, allowing him to work with PT and OT. G-tube and tracheostomy tube were placed for medications, nutritional support, and removal of nasal intubation. Additionally, lower extremity stretch braces were initiated early in the hospital course to prevent mobility loss. Although the feasibility of an intrathecal infusion system was discussed, logistical constraints prevented its use. These procedures and medications were completed to help the patient participate in rehabilitative therapies with more ease, allowing him a safer discharge home with family.

Discussions: Since 2016, approximately 30 tetanus cases are reported yearly in the US among all populations. There are limited case reports about tetanus in the pediatric population from first-world countries. Reviewing the literature, symptom resolution varies widely. There are reports of patients improving back to baseline in 1 week, while others have mild sequela after 6 months. Early rehabilitative therapies as well as implantation of an intrathecal baclofen pump have been shown to reduce spasticity and shorten length of stay.

Conclusions: This case emphasizes the necessity of proactive rehabilitation approaches in tetanus patients. Not only are there considerations to alleviate spasticity, maintain range of motion, and improve agitation but also long-term factors that determine whether the patient would benefit from procedures such as enteral tube feedings, tracheostomy, and intrathecal baclofen that would allow for greater range of rehabilitation therapies, thus contributing to a quicker recovery.